Modifying health education instruction for middle school children with disabilities.

Lucas, Matthew D. ; Kosarchyn, Chrystyna

Introduction

The participation of a student with a disability in health education can often be both challenging and rewarding for the student and teacher. This article will address basic instructional modifications to improve the experience of students with disabilities in the health education setting with a particular focus on middle school. Initially the prevalence of students in special education will be presented. This will be followed by a discussion of the goals of health education, and its particular importance for a student with a disability. Next, a discussion of possible instructional modifications for working with children with disabilities in health lessons will be noted. Lastly, possible modifications for a specific middle school health lesson will be discussed.

During the 2008-2009 school year, 6.5 million of the nation's schoolchildren, ages 3 to 21, received special education services. Thirty-nine percent of those who received services (13 percent of public school enrollment) did so for a specific learning disability. It should be noted that most students with disabilities (86 percent of 6-21 year olds) spend the majority of their time in the general education classroom receiving modified instruction (National Center for Education Statistics, 2011). One such setting is in middle school health education with general education peers.

According to the Centers for Disease Control and Prevention (CDC), "The health of young people is strongly linked to their academic success, and the academic success of youth is strongly linked with their health." (CDC: Coordinated School Health, 2010, p. 1). Helping students stay healthy is a fundamental mission of schools. After the family, the school is the primary institution responsible for the development of young people. To aid schools in the achievement of their fundamental mission, the National Health Education Standards (NHES) have been developed. The NHES are goals for students, that when reached will promote personal, family, and community health. The standards provide a framework for the development of basic health education. Although attaining these goals might be considered very ambitious, it should be stressed that a student's ability to achieve them is very important as they help to ensure a healthy lifestyle through responsible decision making. The following is the list of National Education Health Standards:

* Standard 1: Students will comprehend concepts related to health promotion and disease prevention to enhance health.

* Standard 2: Students will analyze the influence of family, peers, culture, media, technology, and other factors on health behaviors.

* Standard 3: Students will demonstrate the ability to access valid information and products and services to enhance health.

* Standard 4: Students will demonstrate the ability to use interpersonal communication skills to enhance health and avoid or reduce health risks.

* Standard 5: Students will demonstrate the ability to use decision-making skills to enhance health.

* Standard 6: Students will demonstrate the ability to use goal-setting skills to enhance health.

* Standard 7: Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce health risks.

* Standard 8: Students will demonstrate the ability to advocate for personal, family, and community health. (The Joint Committee on National Health Education Standards, 2007).

Health education, which focuses on allowing students to engage in appropriate behaviors, is important for all students, especially for those with disabilities because of the common health concerns of these children. Such concerns may include items associated with breathing, mobility, and the heart--to name a few. The Coordinated School Health (CSH) Program, consisting of eight components, is a model that provides a framework for planning and coordinating school health activities (CDC: Components of Coordinated School Health, 2010). The first component of the CSH Program, health education, "provides students with opportunities to acquire the knowledge, attitudes, and skills necessary for making health-promoting decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others" (CDC: Components of Coordinated School Health, 2010, p. 1). Health education should, ideally, be comprehensive in its nature. This means that courses of study (curricula) should be offered for students in pre-K through grade 12 that address a variety of health topics (CDC: Components of Coordinated School Health, 2010).

In the elementary school setting health education is commonly administered by the general education classroom teacher. As children enter middle and high school, this setting usually changes as these students commonly receive health education from the health education teacher. For the students with disabilities in the Pre-K-12 mainstream classroom, it may be necessary to modify the health education strategies used by the teacher providing health instruction. The teacher may feel unsure of the methods to be used to teach health education to children with disabilities. To help teachers with this task, the following table notes possible instructional modifications for children with disabilities in the health education classroom. These modifications are listed for the following general disability types: learning disabilities, physical disabilities, and behavioral disabilities.

The above are general suggestions for basic instructional modifications for health education for children with disabilities. To illustrate how they might be used, specific adaptations for different disability categories will now be noted for a specific middle school health lesson.

Instructional Modifications for Middle School Children with Disabilities For a Specific Lesson

Name of Activity: Graphically Organized Body Systems (pecentral.org, 2010)

Purpose of Activity: The purpose of this activity is to allow the students to examine the different types of body systems, including how they work.

Prerequisites: Students should have a basic understanding of the different body systems.

Suggested Grade Level: Middle School Grades

Materials Needed: Graphic organizers printed out of the body systems and cut outs of the basic descriptions of each body system, and baggies.

Description of the Lesson: Students are grouped into pairs and are given the answers cut out and not in order. Students must find out where each cut out goes and how the body systems work. The teacher then goes to their desks and checks for the correct answers. If one or more is incorrect the teacher will tell them how many they need to fix. Once 5 or more groups have completed the challenge the class will go over the answers as a group to reinforce the correct.

Assessment Ideas: This can be used as an assessment tool as well as a test. Students should have their own cuts outs and have to fill in the blocks with the right information. Velcro and laminated papers and cut outs might be beneficial for multiple use.

Possible Modifications for Students with Learning, Physical, & Behavioral Disorders.

Students with Learning Disorders

* A simple review of the body systems should be given before the activity begins.

* The activity should be split--half of the cuts outs should be given with half of the body systems.

* The teacher should ensure that the student is not put in a "secondary" role with a partner. The student should be making decisions in the group work.

Students with Physical Disorders

* The teacher should ensure that the materials, such as the cut outs, are easy to handle (this may include modifying size).

* The teacher should allow the student to express himself/ herself using augmentative communication.

* The teacher should monitor the student's fatigue allotting breaks when needed.

* The teacher should ensure that the students are placed in a position where there is no "undue" stress in activities such as that from trying to look or hear the teacher or partner.

* The teacher should ensure that the student is not put in a "secondary" role with a partner. The student should be making decisions in all the group work.

Students with Behavioral Disorders

* The teacher should pick the partners, placing the student with a partner who displays appropriate behavior.

* The teacher should allow the student, and partner, an increased amount of time to complete the task--this can be done by the teacher avoiding checking this group's answer first.

* The teacher should be sure to compliment the student for encouragement--as well as model behavior through complimenting others.

Conclusion

The participation of a student with a disability in health education can often be both challenging and rewarding for both the student and teacher. The rewards can manifest themselves in the ability of the student to practice a healthy lifestyle. This article has hopefully addressed some basic concerns and solutions to improve the health education setting of students with disabilities.

REFERENCES

Annapolis Valley Regional School Board (1996). Meeting the Needs of Students With Disabilities. Retrieved May 26, 2011 from http://www.nsnet.org/start/physical.pdf

Centers for Disease Control and Prevention (2010). Components of Coordinated School Health. Retrieved June 2, 2011 from http://www.cdc.gov/healthyyouth/cshp/components.htm.

Centers for Disease Control and Prevention (2010). Coordinated School Health. Retrieved June 2, 2011 from http://www.cdc. gov/healthyyouth/cshp.

National Center for Education Statistics (2011). Children and Youth with Disabilities (Indicator 7-2011). Retrieved June 2, 2011 from http://www.nces.ed.gov/programs/coe/indicator_ cwd.asp.

PeCentral.org. (2010). Graphically Organized Body Systems. Retrieved May 25, 2011 from http://www.pecentral.org/ lessonideas/ViewLesson.asp?ID=9826

Teaching Modifications for Students with Disabilities.(2010). Dr. Mary Jean Ronan

Herzog's Webpage. Retrieved April 5, 2011 from http://paws.wcu.edu/mherzog/617modideas_001.htm.

The Joint Committee on National Health Education Standards (2007). National Health Education Standards: Achieving Excellence. Atlanta: American Cancer Society, 2007.

Matthew D. Lucas, EdD, CAPE, Assistant Professor of Health and Physical Education

Chrystyna Kosarchyn, PhD, CHES, Professor of Health Education

Department of Health, Athletic Training, Recreation and Kinesiology, Longwood University, Farmville, VA

Table 1: Possible Instructional Modifications for Children with
Disabilities in Health Education

Disability Type Possible Instructional Modifications in
 the Health Education Setting

Learning Disabilities Modify the Presentation of Material

 * Provide an overview of the lesson before
 beginning.

 * Use concrete examples of concepts before
 teaching the abstract (for example, use
 math manipulatives).

 * Model strategies and give examples.

 * Give instructions in more than one
 modality.

 * Teach memory strategies (acronyms,
 acrostics, key words, visualization,
 etc.).

 * Supplement textbooks with graphic
 organizers, visual spatial displays,
 concrete manipulatives, videos, computer
 programs, books on tape.

 * Use peers and cooperative learning
 groups.

 * Relate lessons to the "real world."

 * Monitor the student's comprehension of
 language used during instruction.

 * Provide consistent review of any lesson
 before introducing new information.

 * Highlight important concepts in text of
 material.

 * Allow student to obtain information
 utilizing cassette recorders, computers,
 interviews, calculators.

 Modify Assignments

 * Break assignment into segments of
 shorter tasks.

 * Allow student to report information/
 assignments utilizing cassette recorders,
 computers, interviews, calculators.

 * Notify parents of projects and due
 dates.

 * Reduce the amount of work.

 * Allow increased time for completion of
 assignments.

 * Space short work periods with breaks or
 change of tasks.

 * Assign tasks at an appropriate reading
 level.

 Modify the Environment

 * Seat student in an area free of
 distractions.

 * Help keep student's work area free of
 unnecessary materials.

 * Provide opportunities for movement.

 (Teaching Modifications for Students with
 Disabilities, 2010).

Physical Disabilities Modify the Presentation of the Material

 * Present material in a method that is
 easy to follow--i.e. larger font

 * Allow student to retain a comfortable
 position when receiving information

 * Allow student to present information
 utilizing cassette recorders, computers,
 interviews, calculators.

 * Make allowances for a student's high
 level of fatigue

 * Provide appropriate adaptive equipment
 and technology

 * Provide time for re-teaching.
 Instruction may need to be paced
 differently

 * Provide instruction in the use of
 assistive technology. Ensure total support
 for use of technology

 * Have another student take notes for the
 student with a physical disability if need
 be (Annapolis Valley Regional School
 Board, 1996)

 Modify Assignments

 * Break assignment into segments of
 shorter tasks

 * Allow increased time for completion of
 assignments

 * Space short work periods with breaks or
 change of tasks

 * Allow student to report information
 utilizing cassette recorders, computers,
 interviews, calculators.

 Modify Environment

 * Organize the environment allowing for
 success of all students

 * Allow student to remain comfortable when
 learning

 (Teaching Modifications for Students with
 Disabilities, 2010).

Behavioral Disabilities Modify the Presentation of the Material

 * Present material in a method that is
 easy to follow--try to reduce stress on
 students

 * Allow student to retain a comfortable
 position when receiving information

 Modify Assignments

 * Ensure that the activity is a positive
 learning experience, not a competition
 between students

 * Break assignment into segments of
 shorter tasks.

 Modify Environment

 * In group activities, acknowledge the
 contributions of all students, including
 the student with a behavioral disorder

 * Provide encouragement to all students

 * Expose students with behavioral
 disorders to other students who
 demonstrate the appropriate behaviors

 * Use time-out sessions to cool off
 disruptive behavior and as a break if the
 student needs one for a disability-
 related reason

 * Organize all games that require teams--
 do not allow students to "pick" teams

 * Have pre-established consequences for
 misbehavior, administer consequences
 immediately, and then monitor proper
 behavior frequently

 (Teaching Modifications for Students with
 Disabilities, 2010).